title: Restoration of intestinal continuity after Hartmann's procedure--not a benign operation. Are there predictors for morbidity?
abstract: BACKGROUND
  Restoration of intestinal continuity is usually the second step after Hartmann's procedure and an established procedure in abdominal surgery, particularly for complicated diverticular disease. This descriptive study aimed to examine the morbidity and mortality associated with the procedure and to define potential risk factors.
  
  
  METHODS
  Data from 161 consecutive patients (median age 62 years, median BMI 25.2) undergoing elective surgery with restoration of bowel continuity between October 2001 and November 2008 at the Department of Surgery, University of Heidelberg, were included in this study. The association of potential prognostic variables with postoperative morbidity and mortality were examined by univariate and multivariate analyses.
  
  
  RESULTS
  The median time between the initial operation and the restoration of bowel continuity was 7 months. The median operation time was 185 min with a blood loss of 150 ml and median postoperative hospital stay of 9 days. Fifty-one percent of the patients had an uneventful recovery, whereas 49% had a postoperative complication. Surgical infections occurred in 18% of patients, 3.8% suffered from anastomotic leakage, and surgical re-exploration was necessary in 11.2%. Medical complications occurred in 21.1% of the patients, with pneumonia in 2.5% and urinary tract infections in 1.3%. One patient died 17 days after surgery. Univariate analysis showed that patients taking immunosuppressant drugs had significantly more wound infections and, interestingly, protective ileostomy was associated with postoperative anastomotic stenosis in our cohort. The administration of PRBC and a prolonged hospital were significantly associated with increased postoperative morbidity in the multivariate analysis.
  
  
  CONCLUSIONS
  Restoration of bowel continuity is a surgical procedure with high overall morbidity. The high morbidity confirmed in our study and various other papers justify a randomized clinical study to investigate the one-stage concept with primary anastomosis against the Hartmann's procedure and its reversal.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
authors.forename: Dalibor
authors.initials: D
authors.lastname: Antolovic
authors.forename: Christoph
authors.initials: C
authors.lastname: Reissfelder
authors.forename: Timur
authors.initials: T
authors.lastname: Ozkan
authors.forename: Luis
authors.initials: L
authors.lastname: Galindo
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.forename: Moritz
authors.initials: M
authors.lastname: Koch
authors.forename: Jürgen
authors.initials: J
authors.lastname: Weitz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000714:Anastomosis, Surgical / Q000379:methods*; D015331:Cohort Studies; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000601:surgery; D003125:Colostomy / Q000009:adverse effects / Q000379:methods*; D016001:Confidence Intervals; D003424:Crohn Disease / Q000175:diagnosis / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000379:methods* / Q000401:mortality; D004241:Diverticulum, Colon / Q000175:diagnosis / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005772:Gastrointestinal Transit; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D019651:Plastic Surgery Procedures / Q000379:methods; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult